Alcohol treatments in primary care show limited effectiveness

ABSTRACTBackground: Antipsychotics continue to be widely used in the treatment of behavioral and psychological symptoms of dementia despite their limited effectiveness and well-known risks, including increased mortality. Our aim was to investigate the national pattern of antipsychotic use among community-dwelling persons with and without Alzheimer's disease (AD) in Finland.Methods: The Social Insurance Institution of Finland (SII) identified all persons with a verified diagnosis of AD in Finland on 31 December 2005. A control for each person with AD, matched in terms of age, sex and region of residence, was also identified. Data on reimbursed drug purchases in 2005 were extracted from the Finnish National Prescription Register. Conditional logistic regression analysis was used to calculate odds ratios (ORs) and 95% confidence intervals (CIs) for the use of antipsychotics.Results: The study population comprised 28,089 matched pairs of persons with and without AD (mean age 80.0 years, SD 6.8, 32.2% men). The annual prevalence of antipsychotic use was higher among persons with than without AD (22.1% vs. 4.4%, adjusted OR = 5.91; 95% CI 5.91–6.31). Among persons with AD, the prevalence of antipsychotic use was similar across all age groups. Of the antipsychotic users, 85.2% with AD and 51.3% without AD purchased second generation antipsychotics. Most antipsychotic prescriptions – 67.8% in the AD and 62.9% in the non-AD group – were generated in primary care situations.Conclusion: One-fifth of persons with AD used antipsychotic drugs. Antipsychotic use was six times more prevalent among persons with AD than without AD. Most antipsychotics were prescribed by primary care physicians.

Download Full-text

An Analysis of Primary Care Clinician Communication About Risk, Benefits, and Goals Related to Chronic Opioid Therapy

MDM Policy & Practice ◽

10.1177/2381468319892572 ◽

2019 ◽

Vol 4 (2) ◽

pp. 238146831989257

Author(s):

Elizabeth C. Danielson ◽

Olena Mazurenko ◽

Barbara T. Andraka-Christou ◽

Julie DiIulio ◽

Sarah M. Downs ◽

...

Keyword(s):

United States ◽

Primary Care ◽

Chronic Pain ◽

The United States ◽

Opioid Therapy ◽

Opioid Overdose ◽

Chronic Noncancer Pain ◽

Opioid Prescribing ◽

Limited Effectiveness ◽

Pain Care

Background. Safe opioid prescribing and effective pain care are particularly important issues in the United States, where decades of widespread opioid prescribing have contributed to high rates of opioid use disorder. Because of the importance of clinician-patient communication in effective pain care and recent initiatives to curb rising opioid overdose deaths, this study sought to understand how clinicians and patients communicate about the risks, benefits, and goals of opioid therapy during primary care visits. Methods. We recruited clinicians and patients from six primary care clinics across three health systems in the Midwest United States. We audio-recorded 30 unique patients currently receiving opioids for chronic noncancer pain from 12 clinicians. We systematically analyzed transcribed, clinic visits to identify emergent themes. Results. Twenty of the 30 patient participants were females. Several patients had multiple pain diagnoses, with the most common diagnoses being osteoarthritis ( n = 10), spondylosis ( n = 6), and low back pain ( n = 5). We identified five themes: 1) communication about individual-level and population-level risks, 2) communication about policies or clinical guidelines related to opioids, 3) communication about the limited effectiveness of opioids for chronic pain conditions, 4) communication about nonopioid therapies for chronic pain, and 5) communication about the goal of the opioid tapering. Conclusions. Clinicians discuss opioid-related risks in varying ways during patient visits, which may differentially affect patient experiences. Our findings may inform the development and use of more standardized approaches to discussing opioids during primary care visits.

Download Full-text

Is Accelerated Partner Therapy partner notification for sexually transmissible infections acceptable and feasible in general practice?

Sexual Health ◽

10.1071/sh10031 ◽

2011 ◽

Vol 8 (1) ◽

pp. 17 ◽

Cited By ~ 6

Author(s):

Thomas Shackleton ◽

Lorna Sutcliffe ◽

Claudia Estcourt

Keyword(s):

Primary Care ◽

General Practice ◽

Partner Notification ◽

Primary Care Providers ◽

Health Clinic ◽

Sex Partners ◽

Care Providers ◽

Practice Nurses ◽

Limited Effectiveness ◽

Sexually Transmissible Infections

Background: Partner notification in primary care is problematic and of limited effectiveness despite enthusiasm from primary care providers to engage with sexually transmissible infection (STI) management. Innovative partner notification strategies must be relevant to the primary care context. The aim of the present study was to explore the opinions of general practitioners (GP) and practice nurses on the acceptability and feasibility of a new form of partner notification developed in the specialist setting known as Accelerated Partner Therapy (APT), for sex partners of those diagnosed with a bacterial STI in general practice. APT is defined as partner notification strategies that reduce time for sex partners to be treated, and include partner assessment by appropriately qualified health care professionals and here involve telephone and community pharmacy assessment. Methods: Semi-structured qualitative interviews were conducted with a purposive sample of GP and practice nurses in East London, UK. Results: All participants appreciated the importance of partner notification in STI management and felt that APT would improve their practice. They supported prioritising antibiotic provision for the sex partners with provision for future comprehensive STI screening. Although both models were acceptable and feasible, the majority preferred the sexual health clinic telephone assessment over the pharmacy model. Conclusions: GP and practice nurses welcome new strategies for partner notification and believe APT could provide rapid and convenient treatment of sex partners in general practice. This supports further evaluation of APT models as a partner notification strategy in primary care.

Download Full-text

Fool’s Gold: Psychologists Using Disingenuous Reasoning to Mislead Legislatures into Granting Psychologists Prescriptive Authority

American Journal of Law & Medicine ◽

10.1017/s0098858800002586 ◽

2003 ◽

Vol 29 (4) ◽

pp. 489-524

Author(s):

Brent Pollitt

Keyword(s):

Primary Care ◽

Mental Illness ◽

Nurse Practitioners ◽

Primary Care Physicians ◽

American Psychological Association ◽

The United States ◽

Psychotropic Medications ◽

American Psychological ◽

Training Requirements ◽

Prescriptive Authority

Mental illness is a serious problem in the United States. Based on “current epidemiological estimates, at least one in five people has a diagnosable mental disorder during the course of a year.” Fortunately, many of these disorders respond positively to psychotropic medications. While psychiatrists write some of the prescriptions for psychotropic medications, primary care physicians write more of them. State legislatures, seeking to expand patient access to pharmacological treatment, granted physician assistants and nurse practitioners prescriptive authority for psychotropic medications. Over the past decade other groups have gained some form of prescriptive authority. Currently, psychologists comprise the primary group seeking prescriptive authority for psychotropic medications.The American Society for the Advancement of Pharmacotherapy (“ASAP”), a division of the American Psychological Association (“APA”), spearheads the drive for psychologists to gain prescriptive authority. The American Psychological Association offers five main reasons why legislatures should grant psychologists this privilege: 1) psychologists’ education and clinical training better qualify them to diagnose and treat mental illness in comparison with primary care physicians; 2) the Department of Defense Psychopharmacology Demonstration Project (“PDP”) demonstrated non-physician psychologists can prescribe psychotropic medications safely; 3) the recommended post-doctoral training requirements adequately prepare psychologists to prescribe safely psychotropic medications; 4) this privilege will increase availability of mental healthcare services, especially in rural areas; and 5) this privilege will result in an overall reduction in medical expenses, because patients will visit only one healthcare provider instead of two–one for psychotherapy and one for medication.

Download Full-text